This page addresses follow-up questions and additional information pertinent to our webinar
Breaking the Bundle: Understanding the 2027 Maternity Care Code Restructure.

** The coding information and guidance are valid at the time of publishing. Learners are encouraged to research
subsequent official guidance in the areas associated with the topic as they can change rapidly.

Q; When the level of MDM is being calculated for a prenatal visit, what level of MDM is supported for the element ‘problem addressed’.
A: The AMA has suggested that a normal pregnancy can be considered an ‘unstable chronic condition’. This would support ‘moderate’ for the ‘problem addressed’ element. Consideration of the other 2 MDM elements (data analysis and risk due to further testing or treatment) will determine the overall MDM of the visit.

Q: Will patients have co-pays in 2027 since E/M codes will be reported for prenatal visits?
A: As per ACOG, prenatal care is considered preventive care under the ACA, and as such, should not be charged a co-pay. They advise coders and providers to addend modifier TH to the E/M code to indicate the visit is a prenatal or postpartum service. This may help patients from receiving bills. However, this can be payer specific.

Q: If a patient is seen in the ED by the OB and then is admitted to the hospital that day by the same OB team for labor management, can the ED visit also be reported?
A: Under the 2027 CPT guidelines, when a patient is admitted to a hospital or birthing center for labor management via another encounter (e.g., in a hospital emergency department, office), the E/M service in the initial site may be separately reported. Modifier 25 may be added to the E/M service to indicate a significant, separately identifiable.